694. Impact of COVID-19 Pandemic on Clostridioides difficile Infection Rates and Risk Factors in Maryland

BACKGROUND: While many Healthcare Associated Infection (HAI) rates increased during the pandemic, inpatient C. difficile infection (CDI) rates declined. We compared pre-pandemic (2018-2019) to interpandemic (2020-2021) data, using Maryland’s population-based surveillance data collected through the Emerging Infections Program’s CDI HAIC project, to quantify the impact of COVID-19 on decreases in CDI within different epidemiologic classes (epi classes): HCFO, CO-HCFA, CA (Tables 1 & 2). [Figure: see text] [Figure: see text] METHODS: Using logistic regression, we examined changes in epi class, prior antibiotic use, and basic demographics. We used crosstabulation chi-square analysis to determine proportional differences in case characteristics, pre- and interpandemic. All analyses were conducted using R version 4.2.2. [Figure: see text] RESULTS: Between 2018-2021, we identified 3,822 CDI cases: 1,142 HCFO; 771 CO-HCFA; and 1,898 CA and 11 with incomplete data. Interpandemic cases were 24% less likely to be CA and 31% more likely to be CO-HCFA (Table 3, p< 0.001) than pre-pandemic cases. Though cases were 13% more likely to be classified HCFO, this increase was not significant between periods (Table 3, p=0.09). However, differences were identified between HCFO-LTCF and HCFO-Hospital where HCFO-LTCF cases were 26% less likely interpandemic than HCFO-Hospital cases (Table 4, p< 0.05; Table 3, p=0.04; respectively). Antibiotic use ≤12 weeks prior to collection did not change significantly (Table 5, p=0.7). All-cause hospital admission was 27% less likely interpandemic (p< 0.05). Though our catchment area is predominately White, Black/African American case counts increased while case counts in all other races declined and no differences were observed between sexes (Table 6, p< 0.001; Table 7, p=0.3; respectively). [Figure: see text] [Figure: see text] [Figure: see text] CONCLUSION: Overall CDI case counts declined during the COVID-19 pandemic across all epi classes. The rate of decline of CA was greater than the decrease in CO-HCFA cases. HCFO-LTCF cases declined more than HCFO-Hospital cases. Unexplained case rate differences between races raise health equity concerns needing exploration. Further investigation may determine whether changes in healthcare seeking behavior, changes in infection prevention methods in LTCFs, local COVID-19 restrictions, or other factors may have impacted CDI rates. [Figure: see text] DISCLOSURES: All Authors: No reported disclosures